title: Management of diabetes and associated cardiovascular risk factors in seven countries: a comparison of data from national health examination surveys.
abstract: OBJECTIVE
  To examine the effectiveness of the health system response to the challenge of diabetes across different settings and explore the inequalities in diabetes care that are attributable to socioeconomic factors.
  
  
  METHODS
  We used nationally representative health examination surveys from Colombia, England, the Islamic Republic of Iran, Mexico, Scotland, Thailand and the United States of America to obtain data on diagnosis, treatment and control of hyperglycaemia, arterial hypertension and hypercholesterolaemia among individuals with diabetes. Using logistic regression, we explored the socioeconomic determinants of diagnosis and effective case management.
  
  
  RESULTS
  A substantial proportion of individuals with diabetes remain undiagnosed and untreated, both in developed and developing countries. The figures range from 24% of the women in Scotland and the USA to 62% of the men in Thailand. The proportion of individuals with diabetes reaching treatment targets for blood glucose, arterial blood pressure and serum cholesterol was very low, ranging from 1% of male patients in Mexico to about 12% in the United States. Income and education were not found to be significantly related to the rates of diagnosis and treatment anywhere except in Thailand, but in the three countries with available data insurance status was a strong predictor of diagnosis and effective management, especially in the United States.
  
  
  CONCLUSIONS
  There are many missed opportunities to reduce the burden of diabetes through improved control of blood glucose levels and improved diagnosis and treatment of arterial hypertension and hypercholesterolaemia. While no large socioeconomic inequalities were noted in the management of individuals with diabetes, financial access to care was a strong predictor of diagnosis and management.
authors.affiliation: Institute for Health Metrics and Evaluation, Seattle, WA 98121, USA. gakidou@u.washington.edu
authors.forename: Emmanuela
authors.initials: E
authors.lastname: Gakidou
authors.forename: Leslie
authors.initials: L
authors.lastname: Mallinger
authors.forename: Jesse
authors.initials: J
authors.lastname: Abbott-Klafter
authors.forename: Ramiro
authors.initials: R
authors.lastname: Guerrero
authors.forename: Salvador
authors.initials: S
authors.lastname: Villalpando
authors.forename: Ruy Lopez
authors.initials: RL
authors.lastname: Ridaura
authors.forename: Wichai
authors.initials: W
authors.lastname: Aekplakorn
authors.forename: Mohsen
authors.initials: M
authors.lastname: Naghavi
authors.forename: Stephen
authors.initials: S
authors.lastname: Lim
authors.forename: Rafael
authors.initials: R
authors.lastname: Lozano
authors.forename: Christopher J L
authors.initials: CJ
authors.lastname: Murray
mesh_terms: D000328:Adult; D003920:Diabetes Mellitus / Q000175:diagnosis / Q000628:therapy*; D058065:Diabetic Cardiomyopathies / Q000175:diagnosis / Q000628:therapy*; D005260:Female; D006306:Health Surveys; D054625:Healthcare Disparities; D006801:Humans; D006937:Hypercholesterolemia / Q000175:diagnosis / Q000628:therapy; D006973:Hypertension / Q000175:diagnosis / Q000628:therapy; D008297:Male; D008875:Middle Aged; D012307:Risk Factors